感冒发烧拉肚子后,孩子竟然瘫痪了?这是什么怪病?

2019-05-08 徐朔 医学界儿科频道

警惕四大症状:耷拉眼皮,脸歪无力,吞咽困难或吐字不清,突然手脚无力。

病例1

2018年的夏末,家住匹兹堡的4岁男孩儿Orville发烧一段时间后突然左手抬不起来了,父母赶忙带他到医院检查。

MRI(核磁共振)的结果显示他的整个脊髓都出现了异常。此后他的病情迅速发展,最严重的时候他的一只手和双脚都动不了、坐不起来。

Orville因此在医院住了六天,爸爸Michael感到非常难过:“这个病让他经受了很大痛苦,但我们完全不了解是什么造成他生病,也不知道我们能做什么来保护他。”

病例2

另一对父母也回忆了让他们心碎的类似经历:他们的儿子布莱登曾经是一个活泼好动的健康小男孩儿。

2016年的7月,他得了一次看似普通的感冒。几天之内,这个平常爱跑爱跳的小男孩就突然瘫痪了。父母给记者展示了一张照片,解释道:这是他生病前最后一次能自主呼吸的时刻。随后他被直升机紧急送进了医院,被插管,上呼吸机……医生最初也对病因一头雾水,花了好多天才通过MRI确诊。

此后布莱登又经历了一系列的治疗和康复训练,整个家庭在医院度过了五个多月的艰难时光。当他坐着救护车回家的那一天,社区里的伙伴们都举着标语来欢迎他。


住院期间的布莱登。图片来源:NBC News

但是到现在布莱登也没有完全恢复:今年7岁的他仍然不能自己吃饭,甚至吞咽都很困难。虽然可以趔趄地走路,但是手臂仍然没有力气。他需要24小时被照看和每周多次的高强度康复训练。

那次生病,完全改变了一家人的生活。


正在进行康复训练的布莱登。图片来源:NBC News

这两个病例并非个例 

最近几年,美国各州发生的不明原因引起的类似病例数显著增加。

2014年之前仅在美国几个州有散在病例;
2014年则扩散到34个州,共出现129例;
2016年这一数字增长到39州149例;
到2018年在40州共发现了210例)。

这引起了美国疾病预防和控制中心(CDC)的注意。


2018年美国各州确诊病例的分布。图片来源:cdc.gov/CDC

这种怪病最初于2012年在加州小规模流行,加州的儿童神经科医生将这一情况报告给CDC,后来该病被定名为“急性无力脊髓炎”(Acute Flaccid Myelitis,AFM)。

它虽然罕见(CDC估计目前美国的发病率为1-2名/每100万儿童),但是后果往往十分严重:病情发展非常迅速,许多孩子一旦患病短期内可能难以完全恢复运动能力。活蹦乱跳的小朋友,可能突然就再也站不起来,对孩子本人和家庭无疑都是噩梦般的沉重打击。我们有必要给予这种疾病更多的关注了。


明尼苏达的7岁男孩Quinton Hill,他是2018年10月该州被诊断为AFM的六名小患者中的一名,幸运的是他经过治疗已经恢复了健康。图片来源:NBC News
 
“急性无力脊髓炎”是什么? 

这个专业名词大家可能觉得有些绕口。但是说起“小儿麻痹症”一定不陌生。引起小儿麻痹的脊髓灰质炎病毒,就是“脊髓炎”的一种常见病因。随着减毒疫苗的普及,脊髓灰质炎已经得到了有效的预防控制。

目前这种“急性无力脊髓炎”的症状和“脊髓灰质炎”十分相似,但病因则尚不明确。

“关于急性无力脊髓炎我们知之甚少。尽管各方都在努力研究,我们仍未找出导致这一疾病的原因。这一事实十分令人沮丧。”CDC接种免疫和呼吸道疾病中心的负责人Dr.Nancy Messonnier说道。


我们的脊髓分为中央的蝴蝶型的灰质和周围的白质,内部像电线排布着密密麻麻的神经,负责在大脑和身体各部位之间来回传输着信号。脊髓炎引起信号传输异常,导致了无力、瘫痪等相关症状。

急性无力脊髓炎的初期症状并不明显。大多数患病的孩子一开始看上去不过是得了一场普通的感冒、发烧或者是拉了几天肚子,却会在之后的几小时到几天内突然出现手脚无力甚至瘫痪。偶尔小患者也会出现感觉发麻刺痛或者尿尿困难等症状。

最让医生担心的是呼吸肌的瘫痪,这会引起呼吸衰竭,造成生命危险。严重的病情尤其常发生在年龄比较小(平均患病年龄为4-6岁)的孩子身上。


急性期AFM导致身体各处肌肉的瘫痪,最令人担忧的是呼吸肌的麻痹。图片来源:NBC News

家长应当对孩子出现的相关症状保持警惕,及时就医。儿科医生应该对前来就诊的有类似症状的孩子进行详细的神经系统体检和实验室检查,必要时做MRI。

目前对于这一疾病的最佳治疗方案尚无定论,多数由医生根据病情对症治疗。

需要注意的是,由于脊髓炎症会广泛影响运动系统,度过最严重的急性期之后,孩子可能还要长期经受疼痛、复视、跛脚、脊柱侧弯等等后遗症,影响孩子的外表和日常活动,对孩子的自信心和心理健康带来一定负面影响,家长和医生应给予密切的关注和心理疏导。


CDC家长教学:怎么识别孩子有可能得了急性无力脊髓炎?警惕四大症状:耷拉眼皮,脸歪无力,吞咽困难或吐字不清,突然手脚无力,请立即就医。

由于目前急性无力脊髓炎的病例还较少,我们对其了解十分有限。虽然病因尚不明确,但科学家怀疑某些病毒可能是罪魁祸首。

比如病例多集中发生于8月到10月间,这正是许多病毒流行的时候。尤其是2014年一种呼吸道病毒EV-D68的流行和急性无力脊髓炎的病例增长有重合,而且多数急性无力脊髓炎患儿的标本中都分离出了这一病毒,因此EV-D68病毒被认为可能和急性无力脊髓炎相关。

其他可能肇事的病原体还包括一些肠道病毒,如EV-A71和EV-D70。

由于确切的病原体和传播方式还不清楚,所以CDC建议最好的预防手段就是保持良好的卫生习惯:

勤用流动水和香皂洗手,蔬菜瓜果要洗净;
打喷嚏时用纸巾或者衣袖捂住口鼻,不要用手;
家中多通风,对孩子接触比较多的东西如玩具、门把手擦拭消毒;
让孩子和最近生病的人保持距离,自家孩子生病时留在家里。

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    2019-07-30 wjywjy
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    2019-05-10 145cdecbm43暂无昵称

    谢谢分享

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    2019-05-09 ssnine
  4. [GetPortalCommentsPageByObjectIdResponse(id=2070191, encodeId=765a20e0191a0, content=<a href='/topic/show?id=552e561631a' target=_blank style='color:#2F92EE;'>#拉肚子#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56163, encryptionId=552e561631a, topicName=拉肚子)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1072181, createdName=wjywjy, createdTime=Tue Jul 30 16:44:00 CST 2019, time=2019-07-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=366020, encodeId=3066366020b3, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cc7b5089574, createdName=145cdecbm43暂无昵称, createdTime=Fri May 10 21:44:25 CST 2019, time=2019-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1376887, encodeId=63a913e688764, content=<a href='/topic/show?id=ddc13e87938' target=_blank style='color:#2F92EE;'>#发烧#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37879, encryptionId=ddc13e87938, topicName=发烧)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25c8396, createdName=ssnine, createdTime=Thu May 09 23:44:00 CST 2019, time=2019-05-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1442993, encodeId=1692144299327, content=<a href='/topic/show?id=fe69e126189' target=_blank style='color:#2F92EE;'>#瘫痪#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71261, encryptionId=fe69e126189, topicName=瘫痪)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=45265003536, createdName=ms1948154235210413, createdTime=Thu May 09 23:44:00 CST 2019, time=2019-05-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=365926, encodeId=1d06365926c9, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eqYPFHuMA3bhYQrHvycmum7IJoCsLK0FP6X56Eoj9PZAECDke8zLCKxZZvk9q7B6rZmPuFgN5YCfw/132, createdBy=00912551888, createdName=12543c13m83暂无昵称, createdTime=Wed May 08 19:30:55 CST 2019, time=2019-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=365905, encodeId=cfbb365905f1, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Wed May 08 08:58:46 CST 2019, time=2019-05-08, status=1, ipAttribution=)]
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    2019-05-08 12543c13m83暂无昵称

    谢谢分享

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=2070191, encodeId=765a20e0191a0, content=<a href='/topic/show?id=552e561631a' target=_blank style='color:#2F92EE;'>#拉肚子#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56163, encryptionId=552e561631a, topicName=拉肚子)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1072181, createdName=wjywjy, createdTime=Tue Jul 30 16:44:00 CST 2019, time=2019-07-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=366020, encodeId=3066366020b3, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cc7b5089574, createdName=145cdecbm43暂无昵称, createdTime=Fri May 10 21:44:25 CST 2019, time=2019-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1376887, encodeId=63a913e688764, content=<a href='/topic/show?id=ddc13e87938' target=_blank style='color:#2F92EE;'>#发烧#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37879, encryptionId=ddc13e87938, topicName=发烧)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25c8396, createdName=ssnine, createdTime=Thu May 09 23:44:00 CST 2019, time=2019-05-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1442993, encodeId=1692144299327, content=<a href='/topic/show?id=fe69e126189' target=_blank style='color:#2F92EE;'>#瘫痪#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71261, encryptionId=fe69e126189, topicName=瘫痪)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=45265003536, createdName=ms1948154235210413, createdTime=Thu May 09 23:44:00 CST 2019, time=2019-05-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=365926, encodeId=1d06365926c9, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eqYPFHuMA3bhYQrHvycmum7IJoCsLK0FP6X56Eoj9PZAECDke8zLCKxZZvk9q7B6rZmPuFgN5YCfw/132, createdBy=00912551888, createdName=12543c13m83暂无昵称, createdTime=Wed May 08 19:30:55 CST 2019, time=2019-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=365905, encodeId=cfbb365905f1, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Wed May 08 08:58:46 CST 2019, time=2019-05-08, status=1, ipAttribution=)]
    2019-05-08 龙胆草

    学习谢谢分享

    0

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